Question

Explain why the following occur or are associated with diabetic ketoacidosis

o Associated with Type 1 not Type 2 DM

o Increased acetone in blood/urine

o Decreased serum pH

o Kussmaul respirations

o Decreased PCO2

o Increased urination

o Increased blood glucose

o Little or absent insulin

Answer 1

°Diabetic ketoacidosis can occur only when there insufficient or deficiency of insulin.In type 1 diabetes there is absolute lack of insulin production from the body when this is not provided from external source ,the process of ketogenesis occurs leading to DKA but in type 2 there is presence of insulin in the body which can act during the process of ketogenesis and inhibits DKA

°When the body lacks insulin ,the glucose from the blood cannot reach the cells.Now the cells in need of energy activates the regulatory hormone and releases triglycerides, this triglycerides breakdown to free fatty acids.Simultaneously due to gluconeogenesis,excess glucogin is released in to blood along with free fatty acids.This free fatty acids are converted to acetone (acetoacetic acid and beta butyrichydrochloric acid) in the blood and increases its level in blood ,further this is increased innthe urine by osmotic diuresis process

°The acetone which is released in the blood reaches the respiratory system causing the a fruity odour of the breath which is called as Kussmaul respiration .

°The acetone or key one when it is continuously released but not used by the peripheral cells leads to metabolic acidosis by decreasing the pH level

°The oxygen needed for the body is deprived and impairing the gas exchange causing a decreased PCO2

°Ketones are organic compound or needs a buffer (sodium) to be excreted out via urine.But where there is sodium ,it pulls the water content also .So the more ketone is buffered the more water flows in and increasing the urination

°The increased blood glucose level is due to gluconeogenesis .This is because there is already glucose in the body but insulin to deliver it to the cells,hence making the cells to think that there is no glucose and bit activates regulatory factors from the liver and further releases glucose in the blood thus increasing the blood glucose level in excess

° In type 1 the beta cells have a deficiency in production of insulin ,where in type 2 the get a cells has insulin but no triggers to release it in to blood and control the blood sugar level